Skin diseases of the elderly
Robert A. Norman in Geriatric Dermatology, 2020
Stasis dermatitis (Figure 7) usually occurs with venous insufficiency, varicose veins, and pedal edema. It results from venous hypertension and deep vein thrombosis. There is a brownish discoloration of the skin from hemosiderin deposition. Chronic eczematous dermatitis occurs around the ankles (Figure 7a). Trauma can cause ulceration (Figure 7b). Among the complications of the dermatitis and/or ulcer are cellulitis and contact dermatitis from topical medications, especially antibiotics. Some topical medications or a complicating infection can induce autosensitization — the so-called ‘Id’ reaction — which can produce a symmetrical eczematous dermatitis especially of the extremities and/or a dyshidrotic eczematous dermatitis of the hands and feet.
Stasis Dermatitis
Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld in Atopic Dermatitis and Eczematous Disorders, 2014
Stasis dermatitis is a common inflammatory condition, typically affecting the lower legs of middle-aged and elderly patients (Farber and Barnes 1956). It presents as an eczematous dermatitis of the lower legs and ankles against a background of chronic venous insufficiency and lower extremity edema. The severity of stasis dermatitis varies widely from mild, asymptomatic, cutaneous pigmentary alteration to severe eczematous dermatitis with fibrosis and ulceration. The prevalence of stasis dermatitis is around 6–7% in patients aged over 50 years (Beauregard and Gilchrest 1987). This means that more than 15 million people in the USA may have this condition.
Transcutaneous electrical nerve stimulation (TENS): a review of applications in dermatology
Published in Journal of Dermatological Treatment, 2020
Michael J. Visconti, Wasim Haidari, Steven R. Feldman
Electrical stimulation accelerates wound healing according to multiple studies. In a review of randomized clinical trials assessing the efficacy of electrical stimulation for wound healing, electrical stimulation was associated with faster wound area reduction or a higher proportion of wounds that healed. This acceleration in wound healing is able to promote the survival of flaps and grafts, accelerate postoperative recovery and decrease necrosis (12). In regard to TENS therapy specifically, patients with peripheral artery disease who used TENS treatment for 3 and 6 weeks had an increase in capillary density (p < .005) and transcutaneous oxygen measurements (p < .05) (13). In a double-blinded study of healthy subjects, an increase in laser Doppler blood flow was noted with the use of low-intensity TENS group compared to the control and high-frequency TENS group (p < .05) (14). TENS use improves venous flow in addition to skin perfusion (15). This implication may have a potential benefit in the treatment of cutaneous manifestations related to poor venous blood flow (i.e. stasis dermatitis). Overall, the beneficial effects of TENS therapy on cutaneous perfusion and arterial blood flow may provide improved outcomes related to the healing of cutaneous wounds and survival of skin grafts and flaps during Mohs surgery or cosmetic procedures for the practicing dermatologist.
Topical treatment for postinflammatory hyperpigmentation: a systematic review
Published in Journal of Dermatological Treatment, 2022
Marcus G. Tan, Whan B. Kim, Christine E. Jo, Karina Nabieva, Carly Kirshen, Arisa E. Ortiz
Erythema, as a clinical indicator of inflammation, is more difficult to appreciate in darker skin phenotypes, and is a risk for under-recognition and under-treatment (21). Topical corticosteroids had high quality studies supporting their use in PIH, suggesting that there was likely subclinical inflammation perpetuating the hyperpigmentation in those with longstanding disease. PIH following stasis dermatitis is due to dermal hemosiderophages, in addition to melanin incontinence, which would account for the lack of efficacy seen with corticosteroids (22). Clinicians should first attempt to identify and treat the underlying dermatosis resulting in PIH, prior to initiating treatment for PIH. Topical retinoids and hydroxy acids also have the potential to cause or worsen PIH. Hence, it is critical that any preexisting inflammation is properly treated.
Optimization of process parameters for fabrication of electrospun nanofibers containing neomycin sulfate and Malva sylvestris extract for a better diabetic wound healing
Published in Drug Delivery, 2022
Mohammed Monirul Islam, Varshini HR, Penmetsa Durga Bhavani, Prakash S. Goudanavar, N. Raghavendra Naveen, B. Ramesh, Santosh Fattepur, Predeepkumar Narayanappa Shiroorkar, Mohammed Habeebuddin, Girish Meravanige, Mallikarjun Telsang, Nagaraja Sreeharsha
Neomycin sulfate (NS) is one of the most commonly used topical antibiotics. It is the sulfate salt of neomycin B and C. It is an aminoglycoside antibiotic produced by the growth of Streptomyces fradiae (Nitanan et al., 2013; Geszke-Moritz and Moritz, 2016). It stops proteins from being made by binding to ribosomal RNA, which causes the bacterial genetic code to be read wrong. Except for P. aeruginosa, it kills most Gram-negative bacteria but does not affect anaerobes. Some Gram-positive bacteria, such as staphylococci, are killed by it, but streptococci are not. Neomycin is sold as 20% NS in petrolatum, and it is often mixed with other topical antimicrobials to make it more effective against Gram-positive bacteria. It can be used to treat superficial infections, prevent infections in minor wounds and postsurgery wounds, help treat burns, and deal with secondary infections in long-term skin conditions (Madan et al., 2014; Daneshmand et al., 2018; Paliwal et al., 2020). Even though it is often used to treat stasis dermatitis and chronic leg ulcers, it should be used with care because putting it on skin that is already damaged can cause sensitization, systemic absorption, and possibly systemic toxicity. Another harmful side effect of neomycin is allergic contact dermatitis, which affects 1% to 6% of the population with healthy skin and even more people with damaged skin. Contact dermatitis has been reported in as many as 30% of people with stasis dermatitis or leg ulcers. Neomycin can also cause delayed hypersensitivity, reactions caused by IgE, and anaphylactic reactions. The fact that neomycin could cause resistance is another drawback. Resistance can be caused by plasmids and has been seen in both Gram-positive cocci (like staphylococci) and Gram-negative cocci (like Escherichia coli, Klebsiella, and Proteus) (Madgulkar et al., 2011).
Related Knowledge Centers
- Hemosiderin
- Varicose Veins
- Vein
- Venous Ulcer
- Capillary
- Blood
- Skin
- Pathology
- Skin Condition
- Cellulitis